Danneels Lieven, Cagnie Barbara, D'hooge Roseline, De Deene Yves, Crombez Geert, Vanderstraeten Guy, Parlevliet Thierry, Van Oosterwijck Jessica
Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium;
Department of Radiotherapy and Experimental Cancer Research, Ghent University Hospital, Ghent, Belgium;
J Neurophysiol. 2016 Feb 1;115(2):851-7. doi: 10.1152/jn.00192.2015. Epub 2015 Dec 16.
In people with a history of low back pain (LBP), structural and functional alterations have been observed at several peripheral and central levels of the sensorimotor pathway. These existing alterations might interact with the way the sensorimotor system responds to pain. We examined this assumption by evaluating the lumbar motor responses to experimental nociceptive input of 15 participants during remission of unilateral recurrent LBP. Quantitative T2 images (muscle functional MRI) were taken bilaterally of multifidus, erector spinae, and psoas at several segmental levels (L3 upper and L4 upper and lower endplate) and during several conditions: 1) at rest, 2) upon trunk-extension exercise without pain, and 3) upon trunk-extension exercise with experimental induced pain at the clinical pain-side (1.5-ml intramuscular hypertonic saline injections in erector spinae). Following experimental pain induction, muscle activity levels similarly reduced for all three muscles, on both painful and nonpainful sides, and at multiple segmental levels (P = 0.038). Pain intensity and localization from experimental LBP were similar as during recalled clinical LBP episodes. In conclusion, unilateral and unisegmental experimental LBP exerts a generalized and widespread decrease in lumbar muscle activity during remission of recurrent LBP. This muscle response is consistent with previous observed patterns in healthy people subjected to the same experimental pain paradigm. It is striking that similar inhibitory patterns in response to pain could be observed, despite the presence of preexisting alterations in the lumbar musculature during remission of recurrent LBP. These results suggest that motor output can modify along the course of recurrent LBP.
在有腰痛（LBP）病史的人群中，已观察到感觉运动通路的几个外周和中枢水平存在结构和功能改变。这些现有的改变可能会与感觉运动系统对疼痛的反应方式相互作用。我们通过评估15名单侧复发性LBP缓解期参与者对实验性伤害性输入的腰部运动反应来检验这一假设。在几个节段水平（L3上、L4上和下端板），并在几种情况下，对双侧多裂肌、竖脊肌和腰大肌进行了定量T2图像（肌肉功能MRI）采集：1）静息时；2）无痛进行躯干伸展运动时；3）在临床疼痛侧进行实验性诱发疼痛的躯干伸展运动时（在竖脊肌内注射1.5毫升肌肉内高渗盐水）。实验性疼痛诱发后，所有三块肌肉在疼痛侧和非疼痛侧以及多个节段水平的肌肉活动水平均类似降低（P = 0.038）。实验性LBP的疼痛强度和定位与回忆的临床LBP发作期间相似。总之，单侧和单节段实验性LBP在复发性LBP缓解期会导致腰部肌肉活动普遍且广泛地降低。这种肌肉反应与之前在接受相同实验性疼痛范式的健康人群中观察到的模式一致。令人惊讶的是，尽管在复发性LBP缓解期腰部肌肉组织存在先前的改变，但仍可观察到对疼痛的类似抑制模式。这些结果表明，运动输出可在复发性LBP过程中发生改变。
